Malaria case clinical profiles and Plasmodium falciparum parasite genetic diversity: A cross sectional survey at two sites of different malaria transmission intensities in Rwanda

Fredrick Kateera, Sam L. Nsobya, Stephen Tukwasibwe, Petra F. Mens, Emmanuel Hakizimana, Martin P. Grobusch, Leon Mutesa, Nirbhay Kumar, Michele Van Vugt

Research output: Contribution to journalArticle

Abstract

Background: Malaria remains a public health challenge in sub-Saharan Africa with Plasmodium falciparum being the principal cause of malaria disease morbidity and mortality. Plasmodium falciparum virulence is attributed, in part, to its population-level genetic diversity-A characteristic that has yet to be studied in Rwanda. Characterizing P. falciparum molecular epidemiology in an area is needed for a better understand of malaria transmission and to inform choice of malaria control strategies. Methods: In this health-facility based survey, malaria case clinical profiles and parasite densities as well as parasite genetic diversity were compared among P. falciparum-infected patients identified at two sites of different malaria transmission intensities in Rwanda. Data on demographics and clinical features and finger-prick blood samples for microscopy and parasite genotyping were collected. Nested PCR was used to genotype msp-2 alleles of FC27 and 3D7. Results: Patients' variables of age group, sex, fever (both by patient report and by measured tympanic temperatures), parasite density, and bed net use were found differentially distributed between the higher endemic (Ruhuha) and lower endemic (Mubuga) sites. Overall multiplicity of P. falciparum infection (MOI) was 1.73 but with mean MOI found to vary significantly between 2.13 at Ruhuha and 1.29 at Mubuga (p < 0.0001). At Ruhuha, expected heterozygosity (EH) for FC27 and 3D7 alleles were 0.62 and 0.49, respectively, whilst at Mubuga, EH for FC27 and 3D7 were 0.26 and 0.28, respectively. Conclusions: In this study, a higher geometrical mean parasite counts, more polyclonal infections, higher MOI, and higher allelic frequency were observed at the higher malaria-endemic (Ruhuha) compared to the lower malariaendemic (Mubuga) area. These differences in malaria risk and MOI should be considered when choosing setting-specific malaria control strategies, assessing p. falciparum associated parameters such as drug resistance, immunity and impact of used interventions, and in proper interpretation of malaria vaccine studies.

Original languageEnglish (US)
Article number237
JournalMalaria Journal
Volume15
Issue number1
DOIs
StatePublished - 2016
Externally publishedYes

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Rwanda
Plasmodium falciparum
Malaria
Parasites
Cross-Sectional Studies
Alleles
Malaria Vaccines
Molecular Epidemiology
Africa South of the Sahara
Health Facilities
Population Genetics
Drug Resistance
Fingers
Virulence
Microscopy
Immunity
Fever
Public Health
Age Groups
Genotype

Keywords

  • Malaria
  • Multiplicity of infection
  • Parasite density
  • Plasmodium falciparum
  • Rwanda

ASJC Scopus subject areas

  • Parasitology
  • Infectious Diseases

Cite this

Malaria case clinical profiles and Plasmodium falciparum parasite genetic diversity : A cross sectional survey at two sites of different malaria transmission intensities in Rwanda. / Kateera, Fredrick; Nsobya, Sam L.; Tukwasibwe, Stephen; Mens, Petra F.; Hakizimana, Emmanuel; Grobusch, Martin P.; Mutesa, Leon; Kumar, Nirbhay; Van Vugt, Michele.

In: Malaria Journal, Vol. 15, No. 1, 237, 2016.

Research output: Contribution to journalArticle

Kateera, Fredrick ; Nsobya, Sam L. ; Tukwasibwe, Stephen ; Mens, Petra F. ; Hakizimana, Emmanuel ; Grobusch, Martin P. ; Mutesa, Leon ; Kumar, Nirbhay ; Van Vugt, Michele. / Malaria case clinical profiles and Plasmodium falciparum parasite genetic diversity : A cross sectional survey at two sites of different malaria transmission intensities in Rwanda. In: Malaria Journal. 2016 ; Vol. 15, No. 1.
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AU - Kateera, Fredrick

AU - Nsobya, Sam L.

AU - Tukwasibwe, Stephen

AU - Mens, Petra F.

AU - Hakizimana, Emmanuel

AU - Grobusch, Martin P.

AU - Mutesa, Leon

AU - Kumar, Nirbhay

AU - Van Vugt, Michele

PY - 2016

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N2 - Background: Malaria remains a public health challenge in sub-Saharan Africa with Plasmodium falciparum being the principal cause of malaria disease morbidity and mortality. Plasmodium falciparum virulence is attributed, in part, to its population-level genetic diversity-A characteristic that has yet to be studied in Rwanda. Characterizing P. falciparum molecular epidemiology in an area is needed for a better understand of malaria transmission and to inform choice of malaria control strategies. Methods: In this health-facility based survey, malaria case clinical profiles and parasite densities as well as parasite genetic diversity were compared among P. falciparum-infected patients identified at two sites of different malaria transmission intensities in Rwanda. Data on demographics and clinical features and finger-prick blood samples for microscopy and parasite genotyping were collected. Nested PCR was used to genotype msp-2 alleles of FC27 and 3D7. Results: Patients' variables of age group, sex, fever (both by patient report and by measured tympanic temperatures), parasite density, and bed net use were found differentially distributed between the higher endemic (Ruhuha) and lower endemic (Mubuga) sites. Overall multiplicity of P. falciparum infection (MOI) was 1.73 but with mean MOI found to vary significantly between 2.13 at Ruhuha and 1.29 at Mubuga (p < 0.0001). At Ruhuha, expected heterozygosity (EH) for FC27 and 3D7 alleles were 0.62 and 0.49, respectively, whilst at Mubuga, EH for FC27 and 3D7 were 0.26 and 0.28, respectively. Conclusions: In this study, a higher geometrical mean parasite counts, more polyclonal infections, higher MOI, and higher allelic frequency were observed at the higher malaria-endemic (Ruhuha) compared to the lower malariaendemic (Mubuga) area. These differences in malaria risk and MOI should be considered when choosing setting-specific malaria control strategies, assessing p. falciparum associated parameters such as drug resistance, immunity and impact of used interventions, and in proper interpretation of malaria vaccine studies.

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